JP2006155071A - Electronic chart pharmacotherapy instruction execution system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an electronic chart pharmacotherapy instruction execution system excellent in operability and functionality that can perform an order input, an execution input and the reference of pharmacotherapy every dosing instruction unit and dosing timing unit. <P>SOLUTION: A pharmacotherapy schedule table expansion program 23 disposed in an order execution input terminal 11, in inputting order information using a pharmacotherapy schedule table, switches a specified screen of timing between the case that the usage of dosing is selected if needed according to the user instruction and the case that the usage of dosing in previously planned timing is selected. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to an electronic medical record pharmacotherapy instruction execution system, and more particularly, to an electronic medical record pharmacotherapy instruction execution system capable of inputting a drug therapy order and an execution input in an administration instruction unit and an administration timing unit.

  Conventionally, many management and management systems related to instruction and implementation of pharmacotherapy using an electronic medical record have been proposed, but each system manages a predetermined administration period date for each drug unit (for example, patents). Reference 1). For this reason, the administration instruction of fine drug therapy such as injection to the patient and the judgment of the implementation are determined and treated by a doctor or the like each time according to the medical condition of the patient.

  Since a medical plan for a patient is very important for human life, it is desirable that the medical plan be standardized to a certain extent regardless of the individual doctor's discretion and skill and be of a high quality. In addition, the patient's medical condition changes from day to day, and it is necessary to administer drugs according to the change. There are problems that cannot be directed and implemented.

  Moreover, about some medical practice data, there exists what schedules and records the schedule including time also with a date (for example, refer patent document 2). However, this type of technology is intended to provide printing and display data to make it easier to see the state of medical practice performed in a day, and does not manage the implementation in units of time. Further, the schedule plan table is for managing the entire amount to the last, and is not managed in units of, for example, one ampule for injection. For this reason, even with the system disclosed in Patent Document 2, there is a problem in that it is impossible to instruct and perform administration of a drug according to the patient's medical condition.

Furthermore, in the conventional system, regarding a prescription order, an injection order, a blood transfusion order, etc., a medical doctor such as a doctor dispenses these drugs using a prescription of a paper (form) image, an injection note, a transfusion product application form, etc. An order is entered on the form image for the patient, and in the implementation department such as a ward that receives the order, the administration of the drug is performed based on the dispensed drug and the output form. Therefore, it is necessary for the medical practitioner to input order instructions separately for each drug therapy such as prescription, injection, blood transfusion, etc., and in the implementation department, each drug therapy is individually specified according to the order instruction input for each drug therapy. In addition, since it is necessary to carry out according to the contents of the instructions in the form, the instruction and implementation of the pharmacotherapy has become complicated.
JP 2004-110725 A (Page 6, FIG. 6, FIG. 7) Japanese Patent No. 2815346 (page 11, FIG. 7)

  Various management and management systems related to the instruction and implementation of pharmacotherapy using electronic medical records have been proposed, but a system enabling the instruction and implementation of pharmacotherapy suited to the patient's medical condition that changes every day has been realized. Was not.

The present invention has been made in order to solve the conventional problems, and is an electronic medical record pharmacotherapy excellent in operability and functionality capable of inputting a drug therapy order and executing input in a dosage instruction unit and a dosage timing unit. An object is to provide an instruction execution system.
It is another object of the present invention to provide an electronic medical record pharmacotherapy instruction execution system capable of switching to and inputting a designation screen of an administration timing input method selected from a plurality of administration timing input methods.

  In order to achieve the above object, the electronic medical record pharmacotherapy instruction execution system according to the present invention stores the order information of pharmacotherapy for drugs such as prescriptions, injections, anticancer drug administration regimens, and blood transfusions administered to patients. An electronic medical record pharmacotherapy instruction execution system to be provided, wherein the order information is input to a drug administration instruction unit and an administration timing unit within a date and time, and is connected to the input terminal, and the instruction input is performed by the input terminal A management computer that centrally manages the ordered order information in the drug administration instruction unit and the administration timing unit, and a plurality of administration timing input methods when inputting the administration timing of the order information from the input terminal Pharmacotherapeutic schedule table development program to switch to and enter the designated administration timing input method designation screen Characterized by comprising a.

  Electronic medical record pharmacotherapy instruction with excellent operability and functionality that enables instruction, execution and reference for each drug administration instruction unit by centrally managing data for each drug administration instruction unit and for each administration timing An implementation system can be provided.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a diagram showing an overall configuration of an electronic medical record drug therapy instruction execution system according to an embodiment of the present invention. This electronic medical record pharmacotherapy instruction execution system includes an order execution input terminal 11, a management computer 12 having a database 12a, an execution input terminal 13, a drug department terminal 14, and a reference terminal 15. Yes.

  The order execution input terminal 11 has both a function of creating a drug therapy schedule table 11a for each patient based on the input of order information and a function of recording the execution in the drug therapy schedule table 11a based on the input of execution information. . This pharmacotherapy schedule table 11a includes prescriptions, injections, anticancer drug administration regimens, blood transfusions, and the like (hereinafter, these drugs and drugs are collectively referred to as drugs) performed by medical personnel such as doctors. It is a screen which displays the order information inputted according to the dosing timing in the dosing instruction unit (one dose; for example, one bottle of the injection solution) as an instruction for the medical treatment medical treatment. This administration timing is the administration timing time from the administration start date to the end date of each drug administration instruction unit. The pharmacotherapy schedule table 11 a created in this way is registered in the database 12 a of the management computer 12.

  An enforcer (for example, a nurse) performs a medical practice based on the content of the order information of the administration timing unit specified in the pharmacotherapy schedule table 11a registered in the database 12a of the management computer 12. In this case, the drug dispensed from the pharmacy unit terminal 14 is first administered to the patient by the operator, and the implementation action is input as implementation information from the order implementation input terminal 11 or the implementation input terminal 13. Further, the reference terminal 15 can refer to the order information and implementation of the patient using the reference function. The reference terminal 15 may be the order execution input terminal 11 or the execution input terminal 13. Each order information of the administration timing unit registered and managed in the database 12a has status flags indicating various states such as new / correction, presence / absence of administration for the order information.

  FIG. 2 is a diagram showing in more detail that the functions of the order, execution, and reference described above are processed in a form for each administration timing.

  FIG. 2 (a) shows, for example, order information for 3 days from the month m, and shows the drugs to be administered to the patient at each administration timing time (time can be arbitrarily set) in the morning, noon, and evening. Has been. FIG. 2B shows the execution data input for the instructed order information for which the instructed medical practice is performed. FIG. 2C shows reference data in the case where the order information and the execution data are referred to by a reference function in a form such as a medicine history or a nursing heat type table.

  FIG. 3 shows a flow of pharmacotherapy instruction execution in each department in a hospital to which the electronic medical record pharmacotherapy instruction execution system according to the embodiment of the present invention is applied. The hospital is roughly divided into a doctor section 3a, a department section 3b such as a pharmacy, and a ward or outpatient section 3c. The doctor section 3a is provided with an order execution input terminal 11 operated by a medical person such as a doctor. In addition, a pharmacy department terminal 14 is provided in the department section 3b such as a pharmacy, and an implementation input terminal 13 is provided in the ward or outpatient section 3c.

  Order information of the above-mentioned administration timing unit from a medical person such as a doctor input from the order execution input terminal 11 is sent in units of drug delivery to the department charge comedy in the department section 3b of the pharmacy or the like via the management computer 12. It is sent to the medicine unit terminal 14. At the same time, the order information of the administration timing unit is sent to the execution input terminal 13 of the ward or outpatient section 3c. The departmental comedy medical in the department section 3b of this pharmacy etc. confirms the dispensed drug based on the order information received from the order execution input terminal 11, prepares for the withdrawal, and sends the drug to the ward or outpatient section 3c enforcer. Pay out. The enforcer confirms the dispensed drug, prepares for drug administration, and confirms the procedure and equipment. If the same drug exists at the same dispensing timing and at different administration timings, and there is a drug that can be reused, it is possible to change the dispensing amount according to the designation of the departmental medical.

  And the enforcer with respect to a patient performs a drug administration with respect to a patient based on the order information of the administration timing unit received from the order execution input terminal 11. FIG. Furthermore, the completion of the administration is confirmed, and the condition of the patient is confirmed and the implementation is finished. The work contents of this implementation are sent from the implementation input terminal 13 to the management computer 12 and recorded in the database 12a. At this time, even if it is different from the work content ordered by a medical person such as a doctor, the implementation content at that time is recorded in the administration timing unit. Therefore, the data as performed on the patient in the administration timing unit is recorded in the execution data. As a result, a medical person such as a doctor can always give an accurate instruction based on the order information and the actual execution data. Drugs that have not been used due to drug administration to the patient are returned from the ward or the outpatient of the outpatient section 3c to the departmental comedy in the department section 3b such as a pharmacy.

  FIG. 4 is a diagram showing a form output form using order information in the electronic medical record medication instruction execution system according to the embodiment of the present invention. The order information input from the order execution input terminal 11 is sent to the execution input terminal 13 via the management computer 12. At this time, the order information is also sent to the drug department terminal 14 of the department section 3b such as a pharmacy. The pharmacy department terminal 14 can extract necessary information from the order information, and can output a form such as a prescription or an injection note adapted to specifications used by the pharmacy department, for example. In the blood transfusion department, a transfusion product application form can be output. Furthermore, since the execution input terminal 13 can perform the execution input in units of administration timings, the used amount, the unused amount, and the return management associated therewith can be performed, and the return slip can be output. As described above, in the present system, the order execution input terminal 11 transmits order information conscious of only administration to the patient without being conscious of paying out to the pharmaceutical department or the like. The contents flow directly to the pharmacy terminal 14 and the necessary information is taken in. In addition, the medicine unit terminal 14 can output, for example, an instruction form for the payout period automatically extracted by the management computer 12.

  FIG. 5 shows the configuration of the order information input mechanism and display mechanism of the electronic medical record pharmacotherapy instruction execution system according to the embodiment of the present invention.

  This order information input mechanism and display mechanism includes the order execution input terminal 11, the electronic medical record management program unit 21, the database 12a, the reference table 22, and the electronic medical record extraction / display program unit 24. . Among these, the electronic medical record management program unit 21, the database 12a, and the electronic medical record extraction / display program unit 24 are provided in the management computer 12, but are not limited to these forms. The reference table 22 is provided in the order execution input terminal 11, but may be provided in the management computer 12.

  The order execution input terminal 11 has a pharmacotherapy schedule table development program 23. Under the control of the pharmacotherapy schedule table development program 23, order information is input to the patient in units of drug administration instructions and in units of administration timing. Done. Details of the input screen (drug therapy schedule table screen) for realizing the input of order information in this drug administration instruction unit and in the administration timing unit and the display processing thereof will be described later.

  In the database 12 a of the management computer 12, order information and execution data input from the order execution input terminal 11 are stored as electronic medical records via the electronic medical record management program unit 21. The database 12a stores patient personal information, medical care information, and the like, and stores patient information in advance as a patient database.

  The reference table 22 is a reference information storage means for registering and providing in advance a variety of content information that supports order input when order information is given from the order execution input terminal 11 in units of administration timing in units of drug administration instructions. is there. Here, as an example, a check table 22a that is referred to in the determination of suitability for drug combinations, preparations, etc., a drug master table 22b that is referred to in drug selection, designation, etc., when a medication timing is designated, etc. Although the time information table 22c and the like to be referred to are disclosed, the present invention is not limited to this, and items in which input items can be registered in advance are registered in the reference table 22.

  The electronic medical record extraction and display program unit 24 reads out the order information and the electronic medical record and patient information of the execution data stored in the database 12a and sends them to the order execution input terminal 11, as well as the execution input terminal 13 and the pharmacy unit terminal 14 of each department. Have a function to send to The order execution input terminal 11, the execution input terminal 13, and the drug department terminal 14 are used for nursing display, drug department display, drug history display, and the like.

  FIG. 6 is a diagram showing a more detailed configuration of the electronic medical record management program unit 21 described above. Order information input from the order execution input terminal 11 using the reference table 22 is temporarily stored in the order input data file 21a. The temporarily stored order information is input to the administration timing data creation processing unit 21b. The administration timing data creation processing unit 21b activates the individual data creation processing unit 21c, and administers the administration timing management file 21d, the order information, and the like. The administration index file 21e for administration timing and the working file 21f are centrally managed.

  That is, the individual data creation processing unit 21c is configured to be able to centrally manage a plurality of files for managing drugs to be administered to a patient. Patient information read from the database 12a is also stored in the administration timing management file 21d, and administration timing is managed by this file 21d. The index file 21e is linked to the administration timing management file 21d, and order information that matches the administration timing can be read. The order input from the order execution input terminal 11 can instruct a plurality of administration timings at once, but is managed individually after development at the administration timing. Although the management unit differs between the order and the implementation, the system manages them with the index file 21f. Thereby, even if a part of the administration timing is an executed order, the administration timing for an unexecuted part can be input as an order change operation. The working file 21f stores a list of tasks related to administration to the enforcer, and can output a list of medication actions.

  FIG. 7 is a diagram logically showing an input screen configuration of the pharmacotherapy schedule table 11a. As an input field of each administration instruction unit of groups 1 to n, a common unit 4a configuring the input screen, and a calendar unit are provided. And a timing unit 4b. As shown on the lower side of FIG. 7, the components input to the common unit 4a differ for each drug therapy such as prescription, injection, blood transfusion and the like. For example, for prescriptions, it is composed of drugs, usage, and common comments, and drugs are further composed of drug dose / dose unit, drug unit comments, and the like. Regarding injection, it is composed of drugs, procedures, routes, lines, sites, and common comments, and drugs are further composed of drug dose / dose unit, drug unit comments, and the like. Regarding blood transfusion, it is composed of a preparation and a site, and the preparation is further composed of a quantity / quantity unit, a preparation unit comment, and the like.

  As shown in the right side of FIG. 7, the components of the timing unit 4b are configured by administration (execution) timing, administration rate (flow rate), dosage, and administration timing unit comment, and the administration (execution) timing is the start date and time. It is composed of the end date and time, and the number of times and the time width of the day can be arbitrarily set according to the medical condition and the condition of the patient. By setting the administration timing to the minimum unit of the entire system, it is possible to give detailed instructions to the practitioner and to give instructions to the department in charge for the administration timing unit. The instructions mentioned here are those that enable instructions such as dosage, administration speed, instruction comments to the practitioner, payout location, embodiment, etc., and grouping also enables instructions in the same image as the existing system .

  FIG. 8 shows an example of the drug therapy schedule table 11a. Here, an example of the drug therapy schedule table related to injection is shown. The drug therapy schedule table 11a is provided with a new prescription input button 4c for newly inputting order information.

  One administration instruction unit for the patient is extracted from the order examples of the drug therapy schedule table 11a shown in FIG. 8, and the relationship with FIG. 7 will be described. In the order example, “100 ml / 2 physiological saline solution” and “500 mg 2 ml / 1 A (ampule) ascorbic acid injection solution” are the drug dose / dosage unit of FIG. The patient name is patient information from the database 12a, and the date is the order date. “IVH”, “central main”, “LINE2”, and “upper arm” are the procedures and routes in FIG. These constitute the common part 4a of FIG. “Dosage: total amount 202 ml” and “administration rate: over 2 hours” are the administration rate (flow rate) and dose of FIG. “October 14 to 18” is the administration period, “10: 0 to 12:00” is the first administration start date and time and the administration end date and time, “15: 0 to 17:00” is the second administration. The start date and time and the administration end date and time. These constitute the timing unit 4b of FIG.

  From this order, it can be seen that 200 ml of physiological saline and 2 ml of ascorbic acid injection are administered by IVH over 2 hours from the upper arm. Furthermore, as the administration timing, it can be seen that the administration is divided into two times from 10 am to 12:00 and from 3 pm to 5 pm over 5 days from October 14 to 18. In this order example, administration is performed at the same timing for all five days, but the administration timing can be arbitrarily set as described above. Further, it can be understood from the order example of FIG. 8 that if the content of one administration instruction unit is different, the same patient is managed separately. For this reason, according to the present embodiment, it is possible to set a pharmacotherapy schedule suitable for a medical condition or a patient's condition.

  Further, for example, on October 14, it is clearly shown that the administration in the morning is finished (end of implementation) and that the withdrawal of the drug in the afternoon is finished. As described above, since the execution input can be performed at each administration timing, the status, the instruction date / time, and the execution date / time of the administration timing unit can be individually managed. In addition, order information and implementation information of drug therapy can be referred to simultaneously by the drug therapy schedule table 11a.

  FIG. 9 is a diagram showing a flow of processing for creating the drug therapy schedule table 11 a of the order execution input terminal 11. The input of order information will be described with reference to FIG. When a new prescription input button 4c or a non-input area of the timing unit 4b provided in the drug therapy schedule table 11a is double-clicked, an order information input support screen 50 is displayed on the order execution input terminal 11. In addition, modification change / cancellation and execution are input from the drug therapy schedule table 11a. These input processes are performed by the drug therapy schedule table development program 23. The processing procedure of the drug therapy schedule table development program 23 is shown in FIGS.

  FIG. 10 is a flowchart showing a processing procedure of order information input and execution input of the pharmacotherapy schedule table development program 23. FIG. 11 is a flowchart showing details of the order development process, and FIG. 12 is a flowchart showing details of the implementation development process.

  In FIG. 10, the order information input and the execution input are divided into three types, that is, the order information input, the execution input, and the case where both the order information input and the execution input are selected. (Not shown). That is, when both the order information input and the execution input are selected, the order expansion process (step S1) is executed, and the execution expansion process (step S2) is further executed. When only the order information input is selected, the order expansion process (step S3) is executed, and when only the execution input is selected, the execution expansion process (step S4) is executed.

  Thus, it is a system with good operability by enabling execution input on the screen of the drug therapy schedule table 11a. This execution input is configured to handle both the immediate execution of the drug before dispensing from the pharmacy and the execution of the drug dispensed from the pharmacy. In addition, since the execution data is linked to the order information and stored in the database 12a (see FIG. 5), in order to register the execution at the same timing as the administration timing at the time of immediate execution, the order information is registered. And the timing of implementation registration can be guaranteed.

  FIG. 11 shows a processing procedure of the drug therapy schedule table development program 23 that develops the order information input using the order information input support screen 50 of FIG. 9 in the drug therapy schedule table 11a. First, the inputted order information is acquired (step S51), and it is determined whether or not it is a new input. If it is determined that the input is a new input (Y in step S52), the procedure, route, line, and part information is acquired from the order information acquired in step S51 (step S53). In addition, the administration start timing is acquired from the order information acquired in step S51 (step S54). Then, the display start date (position) in the drug therapy schedule table 11a is determined (step S55), and the order information is displayed on the determined display start date (position) (step S56).

  On the other hand, when it is determined in step S52 that the change is a change, the order information to be changed in the drug therapy schedule table 11a is searched (step S57), and then the drug, procedure, Each information of a route, a line, and a part is acquired (Step S58). It is determined whether or not there is a change in the acquired drug, procedure, route, line, and site information (step S59). Here, when the change is related to the component of the drug (Y in step S59), the drug therapy schedule table development program 23 treats it as an input of a new drug (automatically in the administration instruction unit). If it is determined that the contents are different), the process proceeds to step S53 described above.

  However, if it is determined in step S59 that the modification is not a modification related to a drug component (N in step S59), the instruction change content in units of administration timing is acquired from the order information acquired in step S51 (step S60). Then, the display timing (change of the display position in the cell) is determined for those for which there is a change in the administration time information (step S61), and further the display timing (position) in the drug therapy schedule table 11a is determined (step S61). S62) and displayed on the drug therapy schedule table 11a shown in FIG. 8 (step S56).

  FIG. 12 is a flowchart showing the procedure of the implementation development process shown in FIG. The implementation development process will be described with reference to FIG. When an execution input is made from the order information input terminal 11 or the execution input terminal 13 to the pharmacotherapy schedule table 11a, the pharmacotherapy schedule table development program 23 executes the execution input support screen 60 (described in FIGS. 19 and 20 described later). Is provided, and the execution input is executed based on the information. First, the execution target order corresponding to the execution input area of the drug therapy schedule table 11a is acquired (step S71), and the execution timing information is acquired (step S72). Then, an implementation input is performed by operating an implementation button (not shown), a display timing position is determined (step S73), and implementation data is displayed on the screen as shown in the drug therapy schedule table 11a of FIG. 8 (step S73). S74). The execution input terminal 13 is set so that at least the support screen for modification / cancellation shown in FIG. 9 can be executed.

  Next, the above-described FIGS. 13 to 16 will be described. FIGS. 13 to 16 show an example of an order information input support screen 50 provided by the drug therapy schedule table development program 23.

  FIG. 13 to FIG. 16 are input screens for order information of administration instruction units related to injection, and FIG. 13 is an input screen for inputting injection drug selection and instruction amount. In this case, the injection medicine referred from the medicine master table 22b of the reference table 22 is displayed on the screen by searching or the like, and an operation of selecting the desired injection medicine from the screen is performed. In addition, a liquid amount, a standard amount, etc. are input from the indicated amount.

  FIG. 14 shows an example of an input screen related to a procedure among procedures, routes, lines, and parts related to injection. The type of procedure is also based on information acquired from the reference table 22. FIG. 15 is an input screen for common comments regarding injection, in which an instruction for an enforcer, an instruction for a pharmacy, and an instruction regarding a payout location are input as comments. FIG. 16 is an input screen for inputting the administration timing in the timing unit 4 b, and the time information is based on the time information acquired from the time information table 22 c of the reference table 22. As the administration timing, selection of year / month / day and selection input of one or a plurality of administration times can be performed.

  FIG. 17 is a flowchart showing the display function of the drug therapy schedule table 11a by the drug therapy schedule table development program 23.

  For example, when the display start date and end date of the patient to be acquired are input from the order input terminal 11 (step S81), the order display date (display start date) is first acquired (step S82). Order information is acquired from the database 12a based on the order display date (step S83). If the order display date and the input date in the order information are the same (Y in step S84), the acquired order information is displayed on the screen (step S85). Next, it is checked whether or not the order information is the final data of the display date (step S86). Here, if it is not the final data, the processes of steps S83 to S86 are repeated. If it is not the same day in step S84, or if it is the final data in step S86, “display date + 1” is executed (step S87). And when the display date of step S86 is before the input end date (N of step S88), the processing of steps S82 to S88 is repeatedly executed. However, if the display date in step S86 exceeds the input end date (Y in step S88), the process ends.

  FIG. 18 is a flowchart showing the order information display procedure in step S85.

  The desired patient order information is acquired from the database 12a (step S91), and the acquired order information is temporarily stored (step S92). Next, drug information is acquired from the order information (step S93), and procedure, route, line, and part information is acquired (step S94). Further, detailed instruction information for the execution date, the execution timing, and the timing unit is sequentially acquired from the order information (steps S95 to S97).

  Next, it is checked whether or not the implementation date is the final information (step S98), whether or not the final date of the administration instruction unit has been reached (step S99), and the order information is the last order information. It is checked whether or not there is (step S100), and if those conditions are satisfied, a drug therapy schedule table 11a is created (step S101).

  If the implementation date is not final information in step S98, the processes in steps S96 to S98 are repeatedly executed. If it is not the last day in step S99, the processes in steps S95 to S99 are repeated. Furthermore, if it is not the last order information in step S100, the processing of steps S91 to S100 is repeatedly executed.

  Next, implementation input will be described with reference to FIGS. 19 and 20. FIG. 19 shows an implementation input screen from the order implementation input terminal 11, and FIG. 20 shows an implementation input screen from the implementation input terminal 13. In any screen, it is possible to input the execution for each timing unit in the administration instruction unit.

  In FIG. 19, each item is an item from order information provided from the system in advance, and administration information at the timing is displayed in the value column. The contents actually implemented from the order execution input terminal 11 are input to the input column for these items. Similarly, the lower side of FIG. 20 is the same as that of FIG. 19 in the case of the input from the input terminal 13 as well. The difference is that the display area is prepared so that it can be seen whether or not the payout is made. This payout information is displayed based on an input from the medicine unit terminal 14.

  FIG. 21 is a flowchart showing the processing procedure of the drug therapy schedule table development program 23 when the order change input / output is instructed from the drug therapy schedule table 11a shown in FIG. FIG. 22 is a support screen 55 for modification / discontinuation provided by the drug therapy schedule table development program 23. The order information modification / change operation is handled as order deletion and new input in the system. Then, depending on the administration timing, there may be a case where both paid-out and unpaid items are mixed, so that the deletion and new input operations all have an unpaid status. In order to solve this, the status immediately before the order is evaluated in the system, and it is configured to take over at the administration timing unit. As a result, only the changed administration timing status is displayed on the screen as if it was changed.

  First, the order to be changed (instruction for each timing) is selected from the left side of the support screen 55 in FIG. 22 (step S111), and if the stop is instructed from the button on the right side of the support screen (Y in step S112), pharmacotherapy The schedule table expansion program 23 cancels the corresponding timing information of the order and ends the process. On the other hand, when the modification change of the order information in the middle of the support screen is instructed (N in Step S112), the drug therapy schedule table development program 23 selects the item to be changed instructed to edit (Step S113), and the change The operation is executed and the process ends (step S114).

  FIG. 23 is a flowchart showing the detailed operation of step S114. First, the progress that can be changed is acquired from the setting data (step S121). Next, the timing is selected (step S122), and the progress information of the selected timing is acquired (step S123). If the acquired progress cannot be changed, the process is terminated (N in step S124), but if it can be changed, it is checked whether or not the changes in steps S125 to S128 are possible. That is, if the drug can be changed in step S125, or if the procedure, route, line, or part can be changed in step S126, the selected timing is stopped (step S129), and a new order is created. As the information (Rp), an administration instruction unit is automatically created for the drug (step S130). As a result, in the case of a change that is important for the present system, the pharmacotherapy schedule table development program 23 automatically processes as a new order is instructed, so that extremely fine management is always performed.

  If the administration timing is changed in step S127 (Y in step S127) and if the instruction of the administration timing unit can be changed in step S128, the selected timing is changed (step S131), and the timing is changed. To affect other timing (Y in step S132), the timing with the influence is changed (step S133), and the process is terminated.

  As described above, when the operator makes an order correction change to the order information of the already set administration instruction unit, the operator orders and administration timing of the administration instruction unit (in the case of change in the administration instruction unit, all administration timings). Will be automatically selected), but at this time, if it is determined that the system cannot be handled as the same order by changing the common part component of the drug, A new order is automatically created. Note that all the administration timings selected as change targets at this time are treated as cancellations. Therefore, the operator can change the order by a single operation without performing both the stop operation and the new input operation at the time of the change.

  FIG. 24 is a diagram showing that, for example, in the input of the timing component in step S55 of FIG. 11, the administration timing designation method can be freely selected from four types. That is, according to the system of the embodiment, when inputting the administration timing of the administration instruction unit of the order information using the pharmacotherapy schedule table 11a, the usage method (one-shot technique) to be administered is selected as necessary. In this case, the designation of the administration timing can be switched between the selected case and the case in which the usage (procedure for systematic administration) is selected at a pre-planned timing. Here, an arbitrary function can be selected from the four patterns of administration timing designation functions. The four patterns of administration timing designation functions are realized by a drug therapy schedule table development program 23 provided in the order execution input terminal 11 and the execution input terminal 13.

  First, in the administration timing designation method shown in FIG. 24A, the administration timing is input using, for example, the input screen of FIG. 16 included in the order information input support screen 50 provided by the drug therapy schedule table development program 23, for example. This is a standard method (setting the administration timing in the timing unit 4b).

  The administration timing designation method shown in FIG. 24B provides a method for automatically calculating the administration end timing (end date and time). That is, when the administration start timing (start date and time), the dose, and the administration rate of the timing unit components in FIG. 7 are input, the drug therapy schedule table development program 23 calculates (automatically calculates) the administration end timing. Then, the administration end timing is input to the administration timing of the drug therapy schedule table 11a as the end date and time of the timing unit component.

  The administration timing designation method shown in FIG. 24C provides a method for automatically calculating a plurality of administration start timings and end timings in one day. That is, when instructing to administer the same drug (administration instruction unit) multiple times a day, the dose, administration rate, administration interval and number of administrations of the timing unit components in FIG. When input, the pharmacotherapy schedule table development program 23 calculates (automatically calculates) a plurality of administration start timings and end timings in one day. These administration start timing and end timing are input to the administration timing of the pharmacotherapy schedule table 11a.

  The administration timing designation method shown in FIG. 24D provides a method for automatically calculating administration start timing and end timing in a plurality of periods. That is, when instructing to administer the same drug (administration instruction unit) a plurality of times in a plurality of periods, if all start timings, all end timings, the drug dose of the timing unit component and the daily dose are input, The therapy schedule table development program 23 calculates (automatically calculates) a plurality of administration start timings and end timings in a plurality of periods. These administration start timing and end timing are input to the administration timing of the pharmacotherapy schedule table 11a.

In the example of FIG. 24D, “2004/10/15 12:00” is input as the total start timing, “2004/10/17 12:00” is input as the total end timing, the drug dose is 1000 ml, and 1 When the daily dose is 3000 ml and the instruction to administer over 8 hours, the start timing to the end timing of the first administration is [2004/10/15 12: 0 to 2004/10/15 20:00]
The start timing to the end timing of the second administration are [2004/10/15 20:00 to 2004/10/16 04:00]
The start timing to the end timing of the third administration are [2004/10/16 04:00 to 2004/10/16 12:00]
Hereinafter, as shown in FIG. 24D, all start timings to all end timings are automatically set. In this case, whether the administration (750 ml) in the last administration time zone [2004/10/17 04:00 to 2004/10/17 12:00] is performed on a dose basis or on a timing basis Will be specified separately.

  Next, timing evaluation and an automatic calculation function by changing the indicated dosage and dosage rate in the dosage timing unit in the display timing input in step S62 in FIG. 11 will be described with reference to FIGS. 25 and 26. FIG. This automatic calculation function changes the dose and rate of administration in response to instructions entered for specifying the duration, interval, number of times of administration, etc. This is a function for setting the administration timing appropriately by performing recalculation of all timings in cases where there is an effect on the administration. With this function, the timing list before and after the change is displayed on the confirmation screen.

  First, FIG. 25 is a flowchart showing the processing procedure of the timing evaluation and automatic calculation function. Here, when an instruction to change the administration timing is given to already inputted order information (Y in step S201), the instructed change timing is acquired (step S202), and whether or not the administration is “continuous”. Is determined by the flag (continuation flag) of the order information (step S203). Here, when the “continuation” of the administration is determined (Y in step S203), the daily dose and the administration rate are acquired from the corresponding order information (step S207). And the process which changes all the timings after a change timing among the timings before a change based on a daily dosage and a dosage rate is performed (step S208).

  If it is determined in step S203 that the administration is not “sustained”, it is determined whether or not an administration interval is designated. If no administration interval is designated (N in step S204), the process is terminated. To do. On the other hand, when the administration interval is specified in step S204 (Y in step S204), the instruction administration interval is acquired (step S205), and the change timing among the timings before the change based on the acquired instruction administration interval. Processing for changing all subsequent timings based on the indicated administration interval is executed (step S206).

  In this way, when the administration timing is changed for the order information of the administration instruction unit input to the pharmacotherapy schedule table 11a, the subsequent administration timing is changed by the automatic calculation function according to the changed administration timing, and the change is made. The contents are provided to doctors, etc. so that they can confirm the changes.

  FIG. 26 shows a display example of a confirmation screen associated with the change in administration timing. Here, the administration timing before the change is arranged on the left half, and the administration timing after the change is arranged on the right half, A list is displayed in a form in which before and after administration timing is compared. For example, in the case of FIG. 26, it can be seen that the second administration was added to 2004/11/02 and the administration of 2004/11/05 was discontinued. Also, the timing from the second administration of 2004/11/02 to the second administration of 2004/11/04 was changed from “over 12 hours” to “over 11.98 hours” and “continuous” From the above determination, it can be seen that the administration timing of the period has been changed by the processing of steps S207 and S208. If there is no problem with the changed timing on this screen, a confirmation operation is performed (here, an OK button is clicked), and the administration timing specified in the pharmacotherapy schedule table 11a is all applicable after the change instruction. The administration timing is changed.

  According to the electronic medical record pharmacotherapy instruction execution system according to the present embodiment, it is possible to centrally manage data for each drug administration instruction unit, and to input the order and execution of drug therapy in the administration instruction unit and the administration timing unit. In this order input, if the content of the administration instruction unit is different, even the same patient is managed separately, so that a detailed drug therapy schedule can be set in accordance with the medical condition and the patient's condition.

  In addition, since the execution input can be performed at each administration timing, the status of the administration timing unit, the instruction date and time, and the execution date and time can be managed individually. Moreover, since the order information and the execution information of the drug therapy can be referred to simultaneously by the drug therapy schedule table 11a, the operability is very good.

  In addition, regarding the designation of the administration timing, a case where a single use method (one-shot technique) to be administered is selected as necessary and a method (manually administered technique) to administer at a pre-planned timing are selected. In some cases, the administration timing designation screen can be switched and designated. At this time, the administration timing is specified by (1) a method of selecting from a list of frequent timings provided by the system, (2) a method of automatically calculating an administration rate, an indicated dose, and an end timing from the start timing, (3 ) Method of automatically expanding start timing and end timing according to the number of daily administrations from the total start timing, dose, administration rate, administration interval, and number of administrations, (4) total start timing, total end timing, drug dose It is possible to specify from various options such as a method of automatically expanding all start timings and end timings within the administration period from the continuous daily dose.

  Further, a continuous instruction can be given at a dose per day based on the dose per administration timing indicated in the administration instruction unit. At this time, the start time (date and time) and end timing (date and time) of the administration period can be automatically calculated by the system from the instructed daily dose, continuous start timing and continuous end timing.

  In addition, in the case where the start time and end time of other timings are affected by changing the dose and the administration speed of some administration timings in response to the instruction input by specifying the duration and the number of intervals, Appropriate administration timing can be set by recalculation of all timings. It is also possible to provide a timing list before and after the change as a confirmation screen.

  Note that the present invention is not limited to the above-described embodiment, and a system can be constructed by changing constituent elements without departing from the gist of the invention in an actual operation stage.

The figure which shows the whole structure of the electronic medical record pharmacotherapy instruction implementation system which concerns on this invention. The figure which shows the form for every administration timing about the order which concerns on embodiment of this invention, implementation, and a reference. The figure which shows the flow of the pharmacotherapy instruction | indication between each department in the hospital using the electronic medical record pharmacotherapy instruction | indication execution system which concerns on embodiment of this invention. The figure which shows the form of the form output using the order information in the electronic medical record pharmacotherapy instruction | indication execution system which concerns on embodiment of this invention. The figure which shows the structure of the input mechanism of the order information of the electronic medical record pharmacotherapy instruction | indication execution system which concerns on embodiment of this invention. The figure which shows the further detailed structure of the electronic medical record management program part which concerns on embodiment of this invention. The figure which shows the input screen structure of the pharmacotherapy schedule table | surface which concerns on embodiment of this invention. The figure which shows an example of the pharmacotherapy schedule table regarding an injection as an example of the pharmacotherapy schedule table which concerns on embodiment of this invention. The figure which shows the flow of the process which produces a pharmacotherapy schedule table in the order execution input terminal which concerns on embodiment of this invention. The flowchart which shows the order information input of the pharmacotherapy schedule table | surface expansion | deployment program which concerns on embodiment of this invention, and the process sequence of execution input. The flowchart which shows the procedure of the order expansion | deployment process which concerns on embodiment of this invention. The flowchart which shows the procedure of the implementation expansion | deployment process which concerns on embodiment of this invention. The figure which shows an example of the 1st input screen of the order information input support screen provided by the pharmacotherapy schedule table expansion | deployment program which concerns on embodiment of this invention. The figure which shows an example of the 2nd input screen of the order information input support screen provided by the pharmacotherapy schedule table expansion | deployment program which concerns on embodiment of this invention. The figure which shows an example of the 3rd input screen of the order information input support screen provided by the pharmacotherapy schedule table expansion | deployment program which concerns on embodiment of this invention. The figure which shows an example of the 4th input screen of the order information input support screen provided by the pharmacotherapy schedule table expansion | deployment program which concerns on embodiment of this invention. The flowchart which shows the display processing procedure of the pharmacotherapy schedule table | surface by the pharmacotherapy schedule table expansion | deployment program which concerns on embodiment of this invention. The flowchart which shows the display processing procedure of order information which concerns on embodiment of this invention. The figure which shows the structural example of the input screen of implementation from the order execution input terminal which concerns on embodiment of this invention. The figure which shows the structural example of the input screen of implementation from the implementation input terminal which concerns on embodiment of this invention. The flowchart which shows the process sequence of the pharmacotherapy schedule table expansion | deployment program when the instruction | indication of a correction change / stop is performed from the pharmacotherapy schedule table | surface which concerns on embodiment of this invention. The figure which shows the structural example of the support screen of the correction change and cancellation provided by the pharmacotherapy schedule table | surface expansion | deployment program which concerns on embodiment of this invention. The flowchart which shows the process sequence of the pharmacotherapy instruction | indication change operation which concerns on embodiment of this invention. The figure which shows the various instruction input means of the administration timing at the time of inputting order information using the pharmacotherapy schedule table | surface which concerns on embodiment of this invention. The flowchart which shows the process sequence of evaluation of the administration instruction | indication timing which concerns on embodiment of this invention, and an automatic calculation function. The figure which shows the example of a display of the confirmation screen accompanying the timing change produced | generated by the automatic calculation function of the administration instruction | indication timing which concerns on embodiment of this invention.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 11 ... Order execution input terminal, 11a ... Drug therapy schedule table, 12 ... Management computer, 12a ... Database (DB), 13 ... Execution input terminal, 14 ... Drug department terminal, 15 ... Reference terminal, 21 ... Electronic medical record management program Part 21a ... order input data file, 21b ... administration timing creation processing part, 21c ... individual correspondence data creation processing part, 21d ... administration timing management file, 21e ... management index file, 21f ... work queue file, 22 ... reference table, 23 ... Pharmacotherapeutic schedule table development program (AP), 24 ... Electronic medical record extraction / display program part, 50 ... Order data input support screen, 55 ... Support screen for modification / discontinuation, 60 ... Implementation input support screen.

Claims (15)

An electronic medical record pharmacotherapy instruction execution system for storing prescriptions, injections, anticancer drug administration regimens for patients, and drug therapy order information for drugs such as blood transfusions for implementation.
An input terminal for inputting the order information into a drug administration instruction unit and an administration timing unit within the date and time;
A management computer connected to the input terminal and centrally managing the order information input by the input terminal in the drug administration instruction unit and the administration timing unit;
A pharmacotherapy schedule table expansion program for switching to and inputting a designation screen of a dosing timing input method selected from a plurality of dosing timing input methods when inputting the dosing timing of the order information from the input terminal. Electronic medical record pharmacotherapy instruction implementation system.   2. The electronic device according to claim 1, wherein switching of the designated screen is switched according to a case in which a single-use method for administration is selected as necessary and a case in which a procedure for long-time administration is selected. Medical record pharmacotherapy instruction implementation system.   The electronic medical record medication instruction execution system according to claim 1, wherein one of the plurality of administration timing input methods is a method of selecting from a list of frequent timings provided by the system.   2. The electronic medical record pharmacotherapy instruction execution system according to claim 1, wherein one of the plurality of administration timing input methods is a method of automatically calculating an administration rate, a dosage, and an end timing from a start timing. 3.   One of the plurality of administration timing input methods is a method of automatically expanding the start timing and the end timing according to the number of administrations per day from the total start timing, the dose, the administration rate, the administration interval, and the administration frequency. The electronic medical record pharmacotherapy instruction execution system according to claim 1.   One of the plurality of administration timing input methods is a method of automatically expanding all start timings and end timings within the administration period from all start timings, all end timings, drug doses, and continuous daily doses. The electronic medical record pharmacotherapy instruction execution system according to claim 1.   2. The electronic medical record pharmacotherapy according to claim 1, wherein the change of the administration timing sets a continuous instruction at a dose per day based on a dose per administration timing indicated in the administration instruction unit. Instruction implementation system.   8. The electronic medical record according to claim 7, wherein the start timing (date and time) and end timing (date and time) of the administration period are automatically calculated and set from the daily dose, the continuous start timing, and the continuous end timing. Drug therapy instruction implementation system.   In the change of the administration timing, the start time and the end time of other timings are affected by changing the dose and the administration speed of some administration timings in response to the instructions input for specifying the duration and the number of intervals. The electronic medical record pharmacotherapy instruction execution system according to claim 1, wherein if there is, an appropriate administration timing is set by recalculation of all timings.   When the administration timing is “persistent”, the daily dose and the administration rate are obtained, and the timing after the change timing among the timings before the change is changed based on the daily dose and the administration rate. 10. The electronic medical record pharmacotherapy instruction execution system according to claim 9,   When the administration timing is not “sustained” but an administration interval is designated, all timings after the change timing among the timings before the change are changed based on the instruction administration interval based on the instruction administration interval. The electronic medical record pharmacotherapy instruction implementation system according to claim 9.   The system according to claim 9, wherein a timing list before and after the change is provided as a confirmation screen.   The pharmacotherapy schedule table development program calculates an end date and time of the administration timing when an administration timing start date and time, an administration rate and a dose are input to the pharmacotherapy schedule table, and the calculated administration timing end date and time The system according to claim 1, wherein the electronic medical record pharmacotherapy instruction execution system is displayed.   The pharmacotherapy schedule table development program is configured such that when the start date and time of administration, the number of administrations, the administration interval, the administration rate, and the dosage are input to the pharmacotherapy schedule table, the start date and time and end of the administration timing for the number of administrations The electronic medical record pharmacotherapy instruction execution system according to claim 1, wherein a date and time is calculated, and the start date and time and end date and time of the calculated administration timing are displayed on the drug therapy schedule table.   When the start date / time and end date / time of administration timing, the drug dose and the continuous daily dose are input to the drug therapy schedule table, the drug therapy schedule table development program 2. The electronic medical record pharmacotherapy instruction execution system according to claim 1, wherein a start date and time and an end date and time are calculated, and the start date and time and end date and time of the calculated administration timing are displayed in the drug therapy schedule table.

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